title: Stroke patterns in neonatal group B streptococcal meningitis.
abstract: Neonatal group B streptococcus meningitis causes neurologic morbidity and mortality. Cerebrovascular involvement is a common, poorly studied, and potentially modifiable pathologic process. We hypothesized that imaging patterns of focal brain infarction are recognizable in neonatal group B streptococcal meningitis. A consecutive case series included term neonates with the following: (1) bacterial meningitis, (2) acute group B streptococcal infection (positive cerebrospinal fluid/blood culture), (3) brain magnetic resonance imaging within 14 days, and (4) acute intraparenchymal focal infarctions (restricted diffusion). Lesions within known arterial territories were classified as arterial ischemic stroke. Clinical presentations, investigations, and neurologic outcomes were recorded. Eight newborns (50% female) with focal infarction were identified. Five presented early (<1 week), and all manifested clinical shock and elevated acute-phase reactants. Less than 50% had prenatal group B streptococcal screening, while 2 of 3 screened were negative. Two distinct patterns of focal infarction were identified: (1) deep perforator arterial stroke to basal ganglia, thalamus, and periventricular white matter (7/8, 88%), and (2) superficial injury with patchy, focal infarctions of the cortical surface (6/8, 75%). Outcomes (mean 23.8 months) were poor, with severe disability or death in 6/8 (75%). Recognizable stroke patterns contribute to severe neurologic outcomes and represent a potentially modifiable pathophysiologic process in neonatal group B streptococcal meningitis.
authors.affiliation: Department of Pediatrics, Pontificia Universidad Católica de Chile, Santiago, Chile.
authors.forename: Marta I
authors.initials: MI
authors.lastname: Hernández
authors.forename: Carmen C
authors.initials: CC
authors.lastname: Sandoval
authors.forename: Jose L
authors.initials: JL
authors.lastname: Tapia
authors.forename: Tomas
authors.initials: T
authors.lastname: Mesa
authors.forename: Raul
authors.initials: R
authors.lastname: Escobar
authors.forename: Isidro
authors.initials: I
authors.lastname: Huete
authors.forename: Xing-Chang
authors.initials: XC
authors.lastname: Wei
authors.forename: Adam
authors.initials: A
authors.lastname: Kirton
mesh_terms: D001426:Bacterial Proteins / Q000134:cerebrospinal fluid*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008581:Meningitis / Q000150:complications* / Q000473:pathology; D012189:Retrospective Studies; D013290:Streptococcal Infections / Q000134:cerebrospinal fluid / Q000150:complications*; D020521:Stroke / Q000145:classification / Q000209:etiology* / Q000473:pathology
chemical_list: D001426:Bacterial Proteins; C034866:streptococcal group A mitogen